Vitrectomy is a minimally invasive ophthalmic surgery primarily used to treat serious eye conditions such as retinal diseases, vitreous hemorrhage, and retinal detachment. The procedure involves removing the cloudy vitreous humor inside the eye and repairing retinal damage to restore visual function. Typically performed under local anesthesia, the surgery uses precise instruments to access the interior of the eye, lasting approximately 1 to 2 hours, with postoperative care required for recovery.
The main goal is to improve retinal blood flow, clear obstructive tissue from the visual pathway, and repair retinal tears or detachments. This surgery can be performed alone or combined with techniques such as laser therapy or gas tamponade, especially in complex cases where traditional treatments are ineffective.
Based on differences in instrument specifications and techniques, vitrectomy is classified into 23G, 25G, and 27G types, with the numbers indicating the needle diameter in millimeters. Smaller needles reduce tissue trauma and accelerate recovery. The surgical mechanism involves three stages: first removing the cloudy vitreous, then repairing retinal tears, and finally injecting balanced salt solution or gas to maintain the eye's structure.
Minimally invasive techniques utilize endoscopy and ultrasonic cutters to precisely remove fibrous tissue, and employ laser photocoagulation or cryotherapy to seal retinal tears. Gas or silicone oil tamponades temporarily fix the retina in place, promoting tissue healing.
Main indications include massive hemorrhage caused by diabetic retinopathy, retinal detachment due to trauma, and floaters with severe fibrous proliferation. Additionally, severe bleeding from macular holes or retinal vein occlusion also necessitates this surgery to clear obstructions.
When conventional medication treatments are ineffective or when lesions threaten retinal attachment, physicians evaluate the necessity of surgery. For example, diabetic patients with vitreous hemorrhage and visual acuity below 0.1, or retinal detachment involving more than one-third of the eye, meet surgical criteria.
The surgery is performed in an operating room, with the patient maintaining a fixed head position. During the procedure, gas or silicone oil tamponades may be used. The surgeon makes three small incisions in the eye for infusion, vitrectomy, and illumination. The process includes:
There are no specific drug dosages involved, but the type of tamponade (such as SF6 or C3F8 gas) is selected based on the patient's condition. Postoperative positioning is crucial to facilitate retinal positioning.
This surgery directly addresses physical obstacles within the retina and vitreous, with a success rate of up to 80-90%. Compared to traditional open surgery, minimally invasive techniques reduce tissue damage, postoperative pain, and recovery time by over 50%.
Potential complications include endophthalmitis, cataract progression, and glaucoma, with an incidence of approximately 1-3%. Within 2-4 weeks post-surgery, patients may experience worsening floaters or visual fluctuations, most of which are reversible.
Serious risks include recurrent retinal detachment (5-10%) and retinal vascular occlusion after gas tamponade. Elderly patients may have increased risk of corneal endothelial damage, requiring preoperative assessment of corneal health.
Preoperative discontinuation of anticoagulants (such as aspirin) for at least one week, and control of blood glucose and blood pressure within normal ranges are necessary. Postoperatively, activities such as flying, high-altitude exposure, and prone positioning should be avoided to prevent displacement of the tamponade.
Contraindications include uncontrolled severe diabetes, acute ocular infections, or systemic bleeding disorders. Patients with prior radiation therapy or corneal endothelial dysfunction require reevaluation of surgical risks.
The surgery can be combined with anti-VEGF injections to treat macular edema; performing cataract surgery simultaneously can address multiple issues at once. When combined with steroid eye drops, intraocular pressure should be monitored closely.
Patients with gas tamponade should avoid alcohol-based products to prevent accelerated absorption of the gas. Those on anticoagulants should coordinate with hematologists for medication adjustments.
According to Taiwanese medical statistics, the retinal reattachment rate after surgery for retinal detachment is 92%, with a median visual improvement of two lines. The three-year re-detachment rate in diabetic retinopathy patients is reduced to 15% postoperatively.
Multicenter studies show that 23G minimally invasive techniques reduce postoperative inflammation by 40% and increase patient satisfaction by 25% compared to traditional 20G surgery. Long-term follow-up indicates a high retinal stability attachment rate of 89% after gas tamponade.
Mild retinal detachments may be treated with laser photocoagulation, but with higher recurrence rates. Severe hemorrhages can be initially managed with anti-VEGF injections, but cannot address retinal tears. Traditional cryotherapy is less invasive but limited in scope. Pharmacological treatments are only suitable for early lesions and cannot treat physical tissue detachment or severe fibrous proliferation.
Usually, patients should avoid lifting objects over 5 kg, bending, or tilting the head below waist level for at least 2 to 4 weeks. The exact duration depends on individual recovery, and physicians will adjust recommendations based on wound healing progress. Excessive strain may increase intraocular pressure and affect surgical outcomes.
Is it normal to experience eye redness or increased discharge after vitrectomy? How should it be handled?Minor eye redness and slight discharge are common post-surgery, but if accompanied by sudden vision loss, severe pain, or yellow-green discharge, it may indicate infection and requires immediate medical attention. Use artificial tears as advised to relieve discomfort, and avoid rubbing the eyes or using eye drops without hand hygiene.
When can normal eye use resume after surgery? How does the success rate of retinal reattachment affect subsequent vision?Initially, avoid prolonged eye use; take a 5-minute break every 30 minutes. For the first two weeks, avoid reading or using electronic devices. The success rate of retinal reattachment is approximately 80-90%. If successful and without complications, most patients see an improvement of 30-50%, but pre-existing retinal damage may limit final visual recovery.
When gas or silicone oil is used for tamponade, what lifestyle restrictions should patients observe?Gas tamponade requires strict avoidance of flying or hyperbaric oxygen chambers, as bubbles may expand and increase intraocular pressure. Silicone oil requires follow-up every 2-3 months to evaluate the need for removal. Both require avoiding prone positions or specific head postures; detailed positioning instructions will be provided by the physician.
What causes flashes of light or recurrence of visual field defects after surgery? How should it be managed?If new flashes or visual field defects occur postoperatively, it may indicate recurrent retinal detachment or displacement of tamponade. Immediate retinal examination is necessary, and the physician may adjust the tamponade or perform laser repair. Regular monthly follow-up within the first three months helps detect such issues early.
%201.svg)
Copyright © 2025 MedFrontiers. All Rights Reserved.
